Individual provider Active NPI

Zachary Ryan Eagle, MD

  • Gastroenterology Physician
  • Travis Afb, CA
National Provider Identifier
1689166290
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
28122 Issued in MS
Practice address
60 MDG/SGCQ
101 Bodin Circle
Travis Afb, CA 94535-1809
Phone
(707) 423-5041
NPI assigned
May 31, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 28122 MS Primary
Internal Medicine Physician 207R00000X 28122 MS

Addresses

Primary practice location

60 MDG/SGCQ
101 Bodin Circle
Travis Afb, CA 94535-1809

Mailing address

60 MDG/SGCQ
101 Bodin Circle
Travis Afb, CA 94535-1809

Other identifiers 1

IdentifierTypeStateIssuer
05603775MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210818003577 MS Practitioner - Internal Medicine 7315281730 Reassigns benefits to 2 organizations
I20260514001476 CA Practitioner - Internal MedicinePractitioner - Gastroenterology 7315281730 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Gastroenterology
Education
Tulane University School of Medicine, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5820 Owens Dr
Pleasanton, CA 94588-3900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Health System Internal Medicine CurrentSince Aug 18, 2021 Accepting new patients
Singing River Health System CurrentSince Aug 18, 2021 Accepting new patients
Singing River Gulfport CurrentSince Oct 27, 2021 Accepting new patients

Locations

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

3109 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 818-1100

1199 Ocean Springs Rd
Ocean Springs, MS 39564
Phone (228) 875-9363

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1689166290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MDG/SGCQ",
            "address_2": "101 BODIN CIRCLE",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MDG/SGCQ",
            "address_2": "101 BODIN CIRCLE",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-5041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EAGLE",
        "first_name": "ZACHARY",
        "middle_name": "RYAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-31",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MS",
            "license": "28122",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "28122",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05603775",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Travis Afb, CA

Sources for this page

Verify at the official NPI Registry.